Many of us who deal with aging parents suffering from dementia have faced the difficulty of imparting to them bad news, or of trying to convince them to accept care that they need when they can no longer live independently. Sometimes, these conservations can become quite heated.
You’ve probably always been told to be truthful with everyone and especially with your parents. But now, some geriatric care experts are beginning to advise caregiving children to employ white lies in order to ease tensions and help parents with dementia to maintain dignity.
Why would anyone advocate lying to a parent?
Let’s first be clear: we’re not talking about big lies, and we’re not talking about employing them with a parent who has normal cognitive function and unimpaired decision-making abilities. We’re only talking about situations in which you are dealing with a parent who is suffering from Alzheimer’s, or other dementia-type disorder, that limits his or her ability to self-manage and make sound decisions.
Aging parents with dementia can often become frustrated, or even recalcitrant, when they perceive that they are losing control of the ability to make decisions for themselves. Their senses of dignity can become more easily offended; they might transfer their anger at their own decline onto the people around them.
But 90% of senior care managers surveyed by the National Association of Professional Geriatric Care Managers (NAPGCM) in April, 2014, said that small lies, or what they call “fiblets,” are OK to tell dementia patients when they refuse care, or when a truth would otherwise be painful for the patient to learn.
So what is a “fiblet?”
According to NAPGCM President Emily Saltz, a fiblet is a small lie that, “is therapeutic because it calms and reassures, reduces anxiety and protects self-esteem.”
The experts who advocated using them in sensitive discussions were careful to caution that they should only be used to support or protect a patient and should never be used for personal gain.
Which “fiblets” are OK?
The majority of geriatric care experts who responded to the NAPGCM survey (83%) felt that telling a demented parent that an in-home caregiver was coming to the parent’s home to help a spouse, or to perform “some other concrete role,” such as helping to keep the house tidy, cook, or make small repairs, could help the parent feel less anxious and might head off a confrontation.
Another common, therapeutic fib that 68% of responding care managers endorsed is telling a demented parent who can no longer safely drive on his or her own that the car is in the shop for repairs. This can prevent the parent from attempting to drive unsafely, or prevent arguments over keys.
68% of care managers also agreed that keeping a dementia patient from knowing the true cost of in-home or assisted care is ok, if knowing that cost would prevent him or her from accepting care. This seems like a no-brainer; if a parent’s only objection to life-improving care is the cost involved, then one cannot allow that cost to be known. Money is the last thing that should keep a person from receiving the care he or she needs.
Over 6 out of 10 care managers also said that they felt it to be OK to avoid telling a dementia patient about family problems that he or she cannot help or control, such as a loved one’s unemployment, an impending divorce, a loved one’s death, a family member’s drug abuse or incarceration, or other peripheral worries. All this would accomplish would be to add to the patient’s overall stress and anxiety level. It’s counterproductive to their care.
If, for example, a significantly demented patient continually asks where her husband is, even though he died years before, most care managers feel it is OK to tell the patient that her husband stepped out for a moment and would be back later. This prevents the patient from having to continually re-learn and re-process her spouse’s death, and alleviates her immediate fear.
You need a supporting team.
Virtually all the care managers who responded to the NAPGCM’s survey agreed that families should approach delicate or sensitive interactions with a clear support group in place, including the involvement of a professional geriatric expert.
All family members need to approach the patient with a unified purpose and a consistent message, so that internal dissensions or conflicts aren’t perceived by the patient and add to his or her general anxiety level.
Again, white lies and fiblets aren’t appropriate for dealing with an aging parent with normal cognition. But when caring for a loved one with advancing dementia, they can be powerful tools for caregivers who want to ease the parent’s anxieties and allow him or her to get the assistance he or she needs.